Provider Demographics
NPI:1083665202
Name:MEDSTAT URGENT CARE CENTERS PL
Entity Type:Organization
Organization Name:MEDSTAT URGENT CARE CENTERS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-463-1123
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-463-1123
Mailing Address - Fax:772-463-3072
Practice Address - Street 1:6522 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6396
Practice Address - Country:US
Practice Address - Phone:772-463-1123
Practice Address - Fax:772-463-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9732Medicare UPIN